Early experience with a new metal stent (endocoilr) for biliary and pancreatic strictures: Limitations of the current design

D. M. Scheider, J. Cohen, J. A. Dorais, P. Kortan, G. B. Haber

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Biliary metallic stents offer improved efficacy due to lower incidences of occlusion and migration. A new coil design is conceptually attractive, but clinical evaluation has been limited. METHODS: The EndoCoilR (EC) [Instent Inc.] is comprised of a nickle-titanium flat wire wound into a coil configuration with a central section of adjacent coils (dia. 24F) and open-coiled flared ends (dia. 26F) to prevent migration. EC shorten upon release from the insertion catheter by 55%. From 9/93 to 12/9515 biliary and 2 pancreatic EC were inserted into 17 pts (14M, mean age 72 yr). 15 biliary stents (length 5.0 to 7.0 cm) were placed into common bile duct (CBD) strictures: malignant-11, benign- 4. Malignant strictures were pancreas- 5, bile duct- 3, and one each of the ampulla, metastatic stomach and colon. Benign strictures were due to chronic pancreatitis- 3 and sclerosing cholangitis- 1. Strictures location was: ampulla-1, distal CBD-12, and mid CBD- 2. Mean stricture length was 3.4 cm. Pancreatic EC (3.5 cm, no flared ends) were inserted into 2 pts with chronic pancreatitis and proximal PD strictures. All pts were prospectively followed to EC occlusion, migration, or death (mean f/u 73d, r: 3-331). RESULTS: Successful insertion was achieved in 13/15 biliary and in 2/2 pancreatic EC (88%). Technical problems with delivery occurred with 2 biliary EC: delivery catheter fracture during forceful removal from a partially expanded stent leaving the tip trapped above the stent and ampullary tissue embedded between open coils of the distal flared end resulting in occulsion and cholangitis 3 d later that required endoscopic removal. Other immediate problems were central section twist (straight @ 20d f/u) and incomplete expansion in 2 (fully expanded at 5 & 21d f/u). Overall, relief of jaundice was achieved in 12/15 (80%). Late complications included EC migration out of the duct (3/15 biliary EC, 1/2 pancreatic EC), pancreatic EC migration into the PD requiring retrieval, and tumor ingrowth causing biliary EC occulsion in 3/15 (cholangitis-1) at a median time of 49d, range 21-150. EC mortality was zero and life-threatening complications occurred in 2/17 pts (12%). Longest EC patency was 331 d. CONCLUSIONS: (1) EC are limited to use in the distal CBD due to their 55% shortening on release. (2) Tight strictures may limit initial EC expansion, thereby delaying biliary decompression. (3) The distal open-coiled end can embed ampullary tissue resulting in occlusion. (4) Flared ends for pancreatic EC are necessary to avoid migration.

Original languageEnglish
Pages (from-to)303
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
DOIs
StatePublished - 1996
Externally publishedYes

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